For reducing financial losses caused by data errors in healthcare
Contact Us to brainstorm how AI can solve your data problems
By infusing medical ontologies with machine learning algorithms
By learning from the data itself instead of manually implementing thousands of business rules
By generating facts rather than fiction, aiding businesses to make better decisions
Opportunity Up-coding in Fee-For-Service and Risk Adjustment dataNearly 11% of Medicare Advantage (MA) payments in fiscal year 2016 were improper according to CMS. This equates to $16 billion of overpayment. Current process to identify and recover MA improper payments consists of random audits of prior payments which are not targeted and are often delayed Under-coding in Risk Adjustment dataOn an average, a health plan leaves 30% of the reimbursement value of at-risk populations on the table due to wrong HCC capture and documentation which results in $17B annual cost of under-reporting patient risk. Our product MCode identifies these under codings in claims data AI-based healthcare data migration$11 B per annum is the direct cost of data engineers and scientists to clean bad data in healthcare Our product MCheck has solved use cases provider data migration testing and detecting data errors leading to lower HEDIS measure. The tool can also be expanded to in/out of network issues and proactive data quality monitoring in claims processing systems What-if-analyses in healthcare policy makingCMS often looks for capabilities in the Risk Adjustment Suite of Systems (RASS) system to do a what-if analysis. They aim to assess business impact on policy changes associated with the Risk Adjustment payments. HiLabs’ MVision offers a configurable solution at various points in RASS processing which allows the business rules to change easily. The impact analysis related to the change can be performed by a business user in an easy to use web-based interface AI/NLP-based Provider directories DQMErrors in provider directories can draw in fines up to $25000 per beneficiary. Surprise billing due to incorrect doctors listing has cost Blue Shield to shell out $38 M in claims adjustments in past 2 years. On the other hand, accessibility issues due to outdated provider directories can lead to a litigation issues and a bad name hence leading to a competitive disadvantage AI/NLP-based provider data managementErrors in provider directories can draw in fines up to $25000 per beneficiary. Surprise billing due to incorrect doctors listing has cost Blue Shield to shell out $38 M in claims adjustments in past 2 years. On the other hand, accessibility issues due to outdated provider directories can lead to a litigation issues and a bad name hence leading to a competitive disadvantage Pro-active Monitoring of High Cost Claims AdjudicationAn aggregate loss in revenue of $79 B annually is estimated due to organizations with risk-based contracts (such as Medicare Advantage, MSSP, NextGen ACO, Comprehensive Primary Care Plus and Managed Medicaid) leaving 30% of the reimbursement value of at-risk populations on the table due to inaccurate/ incomplete coding associated with risk scores payments calculations Market Government BusinessGovernment agencies, like Centers for Medicare & Medicaid Services (CMS) and Office Of Inspector General (OIG), face unique challenges in terms of incorrect Medicare Advantage payments, conducting random and untargeted audits of prior payments, lack of capability to assess business impact due to policy changes to name a few. HiLabs provides accelerating AI solutions which assist government agencies to-
CommercialWith quickly changing environment caused due to rising costs, stricter mandates, digitalization, data privacy and security issues, Health plans are bleeding money, losing their market and are turning obsolete. HiLabs provides accelerating solutions which assist Health plans at multiple fronts-
Individual
We answer questions such as
MedicareTo stay ahead in the Medicare and Medicare Advantage business, Health plans must ensure high quality care while also complying with the rapid change in government regulations HiLabs provides accelerating solutions which assist plans to-
MedicaidTo stay ahead in the Medicaid business, Health plans must ensure high quality care while also complying with the rapid change in government regulations HiLabs provides accelerating solutions which assist plans to-
Products MCheckAn AI based pattern matching tool solves business problems related to-
MCodeA proactive approach to detect under-coding in Medicare Advantage data using a combination of Artificial Intelligence, Medical Ontologies, and Big Data. The tool has already found potential under-payment of $20M MSureThe unguided AI solution detects up-coding in Medicare Advantage data and ER visits by performing comparative data quality and completeness of MA data. The tool has been customized on medical ontologies based learning to fine tune for Risk Adjustment. MSure has found potential overpayment of $80M in just one state (FL) and around $14M in ER visits for a large health plan in the first quarter of 2020 MVisionCMS often looks for capabilities in the Risk Adjustment Suite of Systems (RASS) system to do a what-if analysis. They aim to assess business impact on policy changes associated with the Risk Adjustment payments HiLabs’ MVision offers a configurable solution at various points in RASS processing which allows the business rules to change easily. The impact analysis related to the change can be performed by a business user in an easy to use web-based interface |
Why Us
Our healthcare-focused artificial Intelligence (AI) solution automatically detects data errors without human knowledge or input. It is a rare fusion of AI, big data, and medical ontologies built by a team of technologists and doctors. The easy to use AI platform, trained on 4 billion health records helps the stakeholders to identify hidden anomalies in their data, save costs on potential leakages and integrate disparate healthcare data to find monetizable insights.
Amit Garg
Co-Founder and Chief Executive Officer
Amit Garg
Co-Founder and Chief Executive Officer
As the leader of Hilabs, Amit has the unique opportunity to leverage the various aspects of his professional experience in business development, product development, operations management, consulting, and financial analysis. Being an engineer at heart, the foundation of his experience has been in data, mathematics, technology, and practical implementations to solve business problems. At the beginning of his career, he worked for two companies from their startup phase to successful acquisitions by top private equity firms. Later in his career, while working for Northrop Grumman, he led the implementation of the Centers for Medicare and Medicaid Services (CMS) Encounters Data Processing System (EDPS), created to better calculate risk-adjusted ~$200 Billion capitated payments for Health Plans.
Today, Amit's professional passion is to simplify data mining in healthcare, generating critical insights from the ocean of complex and unorganized healthcare data.
Amit holds an M.B.A. with Distinction in Economics from the Yale University School of Management, and a B.S. in Industrial Engineering from the Indian Institute of Technology, Roorkee.
Neel Butala, MD
Cardiologist, Massachusetts General Hospital
Neel Butala
Cardiologist at the Massachusetts General Hospital
Neel Butala is a practicing Cardiologist at the Massachusetts General Hospital and Harvard Medical School. He worked as a consultant on engagements in healthcare strategy for the Boston Consulting Group. Neel has 16 publications on healthcare quality and outcomes to his name in leading peer-reviewed academic journals. Neel holds an MD/MBA dual degree cum laude from Yale University and an undergraduate degree in Economics magna cum laude from Harvard University.
Anish Garg
Chief Software Architect
Anish Garg
Chief Software Architect
Anish is responsible for maintaining and developing all major products of HiLabs. He leads research and implementation of high-end machine learning algorithms using Big Data technologies. Previously, he was chief architect at Roposo (a video content platform startup) that got acquired by Japan’s SoftBank-backed InMobi Group. Before Roposo, he worked in Algorithmic Trading Strategies teams at Nomura and Lehman Brothers.
Anish holds a Computer Science degree from the Indian Institute of Technology, Delhi and completed a Machine Learning course at Columbia University. He is a Math Olympiad merit holder
Prateek Bansal
Chief Administrative Officer
Prateek Bansal
Chief Administrative Officer
Prateek can be best viewed as an intraprenuer, instrumental in formulating product vision and an expert in product launch strategies. He manages HiLabs india software development operations. Before HiLabs, he built a start-up ground up when it just had two employees working in western suburbs of Mumbai to a successful growing venture. He developed an award-winning social media analytics and engagement platform which was used by the Tata group, a top Indian conglomerate, for consumer marketing. Prateek received his undergraduate degree in computer science from Jaypee University of Information Technology,India.
Amit Garg
President & CEO, HiLabs
Amit Garg
President & CEO, HiLabs Inc.
Amit has over 20 years of extensive experience with successful IT startups and product strategy in healthcare data analytics.
He led the designing of Centers for Medicare and Medicaid Services (CMS) Encounters Data Processing System (EDPS), created to better calculate risk-adjusted capitated payments for Plans. He worked with top healthcare insurance companies to improve efficient identification of data errors and anomalies through ML products.
Amit received an MBA in Healthcare Management and Entrepreneurship from Yale and a BS in Engineering from the Indian Institute of Technology, Roorkee.
Andrew J. Lang
Global CTO, JPMorgan Chase and Former CIO, Anthem
Andrew J. Lang
Global CTO, JPMorgan Chase
Andrew Lang is the Global Chief Technology Officer at JPMorgan Chase where he responsible for evaluating new and emerging technologies and also setting and leading the global technology strategy and shared services, including enterprise architecture, cloud computing, AI/ML, blockchain, API, to name a few.
He is a member of the firm’s Global Technology Leadership Team and Global Technology Operating Committee (GTOC), and chair of the JPMorgan Chase Distinguished Engineer community.
Prior to joining JPMorgan Chase, Andrew was Executive Vice President and Global Chief Information Officer for Wolters Kluwer, Senior Vice President and Chief Information Officer for Anthem/WellPoint, and has held senior IT leadership positions for Cargill, Aetna, USBank, Visa and IBM. Andrew has been recognized as a Premier 100 IT Leader by Computer World, and holds several technology patents
Frank Baitman
Global head of compliance, Genentech and Former CIO, US Department of Heath and Human Services
Frank Baitman
Global head, compliance & strategy, Genentech
Frank Baitman is the Global Head of Compliance & Strategy for Digital Technologies at Genentech and is a former Chief Information Officer of US Department of Health and Human Services. Frank is experienced in Large Scale Operations, Cyber-security, Privacy and Governance, and Digital Health. He is currently a senior advisor to DeSilva & Philips and Npower, and has been an advisor to several other companies in the past
Dimitri Karavias
President, Neocorp and Former Executive Director, Aetna
Dimitri Karavias
President, Neocorp
Dimitri Karavias is the President of Neocorp. He has an extensive background in Information Technology and has successfully delivered integrated products, processes, and complex enterprise systems in a variety of industries viz high tech, financial and healthcare. Dimitri was previously an Executive Director at Aetna, Vice president at U.S. Bank, and Senior Vice President at Visa
Mrugesh Majmudar
Angel Investor
Mrugesh Majmudar
Angel Investor
Mrugesh Majmudar is a small business owner of multiple retail-based businesses in Maryland.
Mrugesh has more than 20 years experience in the retail industry. Mrugesh’s passion is small business entrepreneurhip, and, has invested in several retail and technology start-ups. Prior to joining his family in the retail sector in 2003, Mrugesh worked as an engineering team lead for start-up companies. Mrugesh holds a BS in Electrical Engineering from the University of Maryland, College Park.
Darren Ghanayem
Executive advisor, community health choice and former executive VP, Wellcare
Darren Ghanayem
Executive advisor, community health choice and former executive VP, Wellcare
Darren is currently an executive advisor for several health companies including Community Health Choice.
Previously Darren served as executive vice president and chief information officer in for WellCare where
he was responsible for further advancing WellCare’s technology capabilities to support the company’s focus
on growth and innovation opportunities. He introduced an agile innovation practice, which is used to develop
creative solutions to challenges impacting WellCare members and providers. Darren was a member of the executive
leadership team and reported directly to the CEO.
Prior to joining WellCare, Darren spent more than 15 years with Anthem, formerly WellPoint, Inc.,
where he provided leadership for a broad variety of
technology initiatives. Darren held roles of increasing responsibility, serving as a director, staff VP, VP and
VP/CIO of Anthem’s commercial business unit.
Darren also served as a senior project director with Access Systems, LLC and as a product manager with Reynolds and Reynolds.
Darren earned a bachelor’s degree in aerospace technology with a concentration in computer technology and an associate in
applied science electrical engineering technology from Purdue University.
Notably, in 2013, Darren was recognized as a Computerworld Premier 100 IT Leader, and in 2018 was honored by the Tampa Bay
Business Journal as a CIO of the Year.
Sajan Pillai
Managing Partner, Season Two Ventures and Former CEO, UST Global
Sajan Pillai
Managing Partner, Season Two Ventures
Sajan Pillai is the CEO and Managing Partner of Season Two Ventures, an early stage venture fund based in Southern California. He is also the Chairman of SP Life Care, a senior living and health care platform in India. He has previously served as the CEO of UST Global. Under his leadership, the company grew significantly, from merely 20 employees to more than 25,000 employees today Sajan also holds patents in Internet Computing and Data Systems and has been chosen as one of the elite 100 CEO Leaders in STEM by STEMConnector
Maulik Majmudar, MD
Medical Officer, Amazon and Former Associate Director, Healthcare Transformation Lab, Massachusetts General Hospital
Maulik Majmudar,MD
Medical Officer, Amazon
Dr. Maulik Majmudar is a cardiologist and Medical Officer at Amazon, where he was associated with the launch of Amazon’s Halo- a fat detecting fitness wearable. Maulik was previously Associate Director of the Healthcare Transformation Lab at Massachusetts General Hospital, and an Assistant Professor at Harvard Medical School, where he was responsible for the identification, validation, and implementation of digital health solutions to improve care delivery as well as the patient and provider experience. Dr. Majmudar was also a founding member and chief clinical officer of Quanttus, Inc. a venture-backed medical wearable's startup that was developing a novel wrist-based device for continuous cuff less blood pressure monitoring. He also holds two patents and has had several publications in high-impact journals
Vivek Gore, PhD
President, Primus technology and Former Computer Science Professor, University of Edinburgh, Scotland & University of California, Los Angeles
Vivek Gore, PhD
Founder and Owner, Primus technology Consulting
Vivek Gore is the founder and owner of Primus technology Consulting, which provides consulting services in the area of IT portfolio management, software development and delivery, business strategy etc. He was previously the Senior Vice President of CNSI Vivek has had broad experience in project and program management, innovation, application development, business intelligence, data analytics, AI, ML to name a few. He holds strong domain expertise in Healthcare IT, Census, and Workers' Compensation
Jay Majmudar
Chief Operating Officer, DK Consulting and Former CIO, Client Network Service Inc.
Jay Majmudar
Chief Operating Officer, DK Consulting
Jay Majmudar is the Chief Operating Officer at DK Consulting and also a Strategic Executive consultant providing subject matter expertise on IT Transformations, Cloud Migrations / Adoption, CyberSecurity, Infrastructure Management, IT Acquisition / Procurement, proposal management and project management. He has deployed several cyber security programs, technical architecture and IT infrastructure solutions in the healthcare space
Douglas Cowieson
Former Chief Operating Officer, EmblemHealth
Douglas Cowieson
Proven Health Insurance executive
Douglas Cowieson is a proven Health Insurance executive with a broad based skill-set and deep experience, from international operations leadership and business development to domestic executive roles in Operations, Network Operations, re-engineering and change management. He was previously the Senior Vice President at Emblem, International Business Development Director at Aetna and Managing Director at Medical Access International. Douglas has strong analytical skills paired with an ability to develop detailed plans through to effective execution
The idea for HiLabs was born when Amit Garg and Neel Butala took Venture Capital and Private Equity Investment course together at the Yale School of Management. They both understood the promise that big data held to improve care and cut costs in the healthcare sector. But there was a problem: relevant data was difficult—and expensive—to access. They converted their business plan, which was a finalist in the Yale Entrepreneur Institute competition, into HiLabs.
4808 Weatheroak Dr,
Olney
MD 20832
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+1(571)224-3173
About HiLabs, A cohort of experienced Engineers, Data Scientists and Physicians.
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